Interstitial Cystitis Advice

In the world of IC medical treatment, options tend to fall into one of two main categories: oral medications or bladder instillations wherein medication is placed directly into the patient's bladder via a catheter. The later (for obvious reasons) is often seen as more invasive, as it clearly involves more than just swallowing pills. The merit and effectiveness of bladder treatments varies significantly from patient to patient. Results run the gambit from remission to a worsening of symptoms and every imaginable outcome in between. Leaving many to ask, why can't there just be an instillation which is both quick and affective!

Bladder instillations are not always made up of the same medication, just as there are a variety of oral medications available to try and help IC patients. Over the years ICers have been treated with everything from silver nitrate (now usually seen as an outdated and very caustic form of bladder instillation) to Heparin, Dimethyl Sulfoxide (DMSO) to Bacillus Calmette Guerin. In general (again it varies from patient to patient) a urologist will determine what type of instillation treatment to try on an IC patient and administer anywhere from one or two to several doses of that medication in the ICer's over a period of weeks or months. Just as there are with other types of Interstitial Cystitis treatments, there are pros and cons to bladder instillations, and deciding to go this route is not a choice to be taken lightly.

One thing that many who try instillations note is that affects do not happen over night, or for some people they never occur at all. Others find that instillations help some symptoms be leave others the same or possibly even worsen their severity. IC patients are often left waiting to feel results, if results are to happen, and usually the instillations do not rapidly address IC pain issues.

However recently (just in the last few years) a new and hopeful breakthrough emerged from the world of IC treatment, something that was quickly dubbed “rescue instillations”. A novel idea which saw the combination of traditional bladder instillation drugs with medications that help to stop (or numb) pain, thereby providing the recipient with quick-acting relief. The hope behind rescue instillations is that they work on more than one level in order to help relieve some (or all) of a person's IC symptoms. They aim to target both bladder inflammation and pain as well as helping to rebuild and strengthen the bladder's interior mucous lining while at the same time even potentially fighting any infection if it's present in the bladder.

Rescue instillations are comprised of what is known as a “cocktail” of different drugs. ICers who have had DMSO instillation treatments may all ready be familiar with this term, as it's sometimes applied to DMSO as well (aka, DMSO is combined with other bladder medications before it is installed). To date there is not a “standard” recipe for this type of bladder cocktail, and many urologists and other doctors who may be treating IC patients create their own “blends” based on what has been shown by others or their own experience to be successful.(Note that the instillation liquid is held in the bladder for a short amount of time, typically between 10 and 20 minutes, if possible, and then expelled from the bladder.)

Blends typically contain either Heparin or Elmiron (in an liquid form, not an oral tablet). The reasoning behind the inclusion of these types of drugs is that they are both widely believed to aid bladder mucous restoration as well as working like a shield to help guard the bladder against potential irritants that pass through it in a person's urine. If a bladder infection or UTI (urinary tract infection) is present an antibacterial can be introduced into the mix, as can something like a corticosteroid (such as Hydrocortisone) which will try to help bring down bladder inflammation levels.

Working to fight IC pain, an instillation formula will usually contain a local anesthetic like marcaine and/or lidocaine, two powerful drugs which work to numb pain in a localized area (in this case the bladder lining). Bladder linings are strong things though and doctors realized that on their own drugs like lidocaine were not usually able to work their way through the tough mucous coating that exists on the bladder lining. This problem was dealt with when researchers found that by alkalizing the anesthetic (with sodium bicarbonate, commonly known as baking soda) it was far more likely to be able to penetrate the mucous level and get to the bladder inflamed/irritated/damaged tissues and nerves below this layer.

In 2005 Dr. Lowell Parsons's rescue formula (which had proved to be quite successful) was tested on newly diagnosed IC patients who were suffering from pain, urinary urgency and frequency during a research study. The group of patients was split into two groups, half received an instillation that contained 1% lidocaine and the other group were tested with an instillation containing 2% lidocaine (a part of their cocktail of ingredients). Just twenty minutes after their first treatment all of the participants in this study were assessed. Group two was further assessed after 24-48 hours and after two weeks. Findings indicated that after one treatment 75% of patients in group one and a staggering 94% of ICers in group two reported that they had significant, immediate IC symptom relief. Further, group two reported that the relief lasted for a minimum of 4 hours after a single instillation, and 80% of group two said that sustained relief had occurred again two weeks later with the new instillation. The testers concluded that intravesical rescue treatment which combins alkalized lidocaine and heparin brought immediate relief in terms of both IC pain and urgency to these newly diagnosed ICers. Symptom relief typically lasted through out the active duration of the local anesthetic, which indicated that the solution suppresses certain types of neurological responses.

What does that mean for you? It may mean that if you are continually experiencing IC flares (times when the severity of your IC symptoms increases) or have not had relief from other types of instillations, or still need more relief from IC than instillations rescue therapy might be the way to go. Once the cocktail is produced the instillation can be done in a doctors office, or (and many ICers opt to go this route) even at home by the ICer, once you've have been properly taught how to preform this procedure on yourself. Rescue therapy has been used on both adults and children with IC.

The thought of using a catheter to instill the treatment can alarm or concern some people, and this is very understandable. Luckily there are some things which can help such as using the smallest (or one of the smallest) size catheter possible (catheter tube size is based on a scale called “French sizes”, the larger the French number the larger the catheter and vice versa). You can ask that the instillation be done with a pediatric catheter which will small sized one as it was designed with the size of a child's urethra in mind. A lot of people who have gone this route also find that using a type of catheter called a “ hydrophilic low friction catheter” can help. This type of catheter has a unique outer layer that helps to reduce friction between the catheter and the urethra (a very important point for those ICers with urethral pain too) during intermittent catheterization. This style also helps to lower the risk of urethral/bladder trauma, discomfort and the potential for infection.

Just as with all types of IC treatments be it oral or invasive, there is no guarantee that rescue treatments will work for you. People who post on IC message boards tend to have mixed feelings on the subject. Not enough research has been carried out to say decisively whether or not the fact that the participants in the study mentioned above responded so well because they were relatively new to the condition (IC). It's affects on long-term IC suffers has not been formally studied formally so far. Yet, if you and your doctor(s) are looking for an alternative (or addition) to oral pain medication and/or other types of bladder instillations this may be the way to go for you. Results can be swift and last for hours, providing some drastically needed IC pain and symptom relief. Instillations usually occur frequently at first and then just as needed or weekly, and again this can be done by the patient themselves in the comfort of their own home. An especially great option for those who amongst us who find car ride or long waits difficult.